- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.55 / $307.36 / $6,300.00
| Professional | | $254.55 | $307.36 | $6,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.35 / $343.35 / $343.35
| Professional | | $343.35 | $343.35 | $343.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.37 / $486.37 / $486.37
| Facility | | $486.37 | $486.37 | $486.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.70 / $429.92 / $833.74
| Professional | | $295.70 | $429.92 | $833.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.08 / $415.11 / $574.30
| Facility | | $311.08 | $415.11 | $574.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.24 / $445.51 / $642.60
| Professional | | $301.24 | $445.51 | $642.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.10 / $517.44 / $613.91
| Professional | | $413.10 | $517.44 | $613.91 |